Risk factors of stroke complicated with hospital-acquired pneumonia: a systematic review and meta-analysis of cohort studies

Abstract

Background: Hospital-acquired pneumonia (HAP) is a common type of nosocomial infection and a common complication experienced by stroke patients during hospitalization. HAP can aggravate patients' primary disease condition and lead to death. Clinically, a variety of factors may affect the occurrence of HAP in patients. In this study, we conducted a meta-analysis of the literature to investigate the risk factors of stroke with HAP for clinical reference. Methods:The PubMed, Medline, Embase and Cochrane Library databases were selected as the sources for the literature search. English-language publications were included. The articles related to stroke with HAP were published from January 2000 to January 2021. The articles were screened and their quality was evaluated using the Newcastle-Ottawa Scale. A meta-analysis was performed of the factors affecting the incidence of HAP using Revman 5.4 software.Results: Ultimately, 7 articles with a total of 1,172 patients were included in the meta-analysis. Of the 1,172 patients, 352 (30.03%) had an HAP infection. The results of the meta-analysis showed that patient age [mean difference (MD) =4.91, 95% confidence interval (CI): 3.90 to 5.93; P<0.00001], National Institutes of Health Stroke Scale (NIHSS) score (MD =3.84, 95% CI: 3.01 to 4.67; P<0.00001), and patient malnutrition [odds ratio (OR) =1.85, 95% CI: 1.13 to 3.04; P=0.02] were risk factors for the development of HAP, while gender, stroke history, smoking history, and comorbidities (diabetes, hypertension, coronary heart disease, and hyperlipidemia) were not risk factors for the development of HAP.Discussion: A total of 7 articles were included in this meta-analysis examining the influencing factors of HAP in stroke patients. The results showed that age, NIHSS score, and malnutrition were risk factors of HAP in stroke patients, while gender, stroke history, smoking history, and complications (diabetes, hypertension, coronary heart disease, and hyperlipidemia) were not influencing factors of HAP.

Factors associated with an increased risk of developing pneumonia during acute ischemic stroke hospitalization

“…Studies of SAP by Chen et al, Xu et al, and Guo et al also found K . pneumoniae to be the most common pathogenic organism [ 67 , 93 , 96 ], and this bacterium has also been linked with aspiration pneumonia [ 11 , 97 – 100 ]. For HAP, the most common causative organisms were carbapenem-resistant A .…”

The efficacy and safety of prophylactic antibiotics for post‐acute stroke infection: A systematic review and meta‐analysis

“…Third, the severity of stroke is a risk factor for infection after stroke. 28 In patients with NIHSS score >15, Thus, patients who have a severe stroke and are at high risk of infection could be considered for prophylactic antibiotics.…”

“…To evaluate the effects of different administration times, we performed a subgroup analysis and found a decreasing trend in pneumonia in patients with early prophylactic use of antibiotics within 24 h after admission (RR 0.81 [95% CI: 0.62–1.07], I 2 = 0%) as compared with those using prophylactic use of antibiotics within 48 h after admission (RR 0.94 [95% CI: 0.79–1.11], I 2 = 0%). Third, the severity of stroke is a risk factor for infection after stroke 28 . In patients with NIHSS score >15, prophylactic antibiotics had a trend to reduce mortality rate (RR 0.63 [95% CI: 0.28–1.41]) and the incidence of pneumonia (RR 0.63 [95% CI: 0.28–1.41]), though there is no significant statistical difference.…”

The efficacy and safety of prophylactic antibiotics for post-acute stroke infection: a systematic review and meta-analysis

“…Third, the severity of stroke is a risk factor for infection after stroke. 27 Thus, patients with severe stroke who are at high risk for infection should be considered for prophylactic antibiotics. However, an RCT with a large sample size included in our meta-analysis involved patients with mild stroke, and the average hospital stay of patients was only 6.35 days.…”